EP3928734B1 - Support lisible par ordinateur avec instructions pour calculer des dimensions projetées d'une dent ayant fait éruption ou pas - Google Patents

Support lisible par ordinateur avec instructions pour calculer des dimensions projetées d'une dent ayant fait éruption ou pas Download PDF

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Publication number
EP3928734B1
EP3928734B1 EP21184102.8A EP21184102A EP3928734B1 EP 3928734 B1 EP3928734 B1 EP 3928734B1 EP 21184102 A EP21184102 A EP 21184102A EP 3928734 B1 EP3928734 B1 EP 3928734B1
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Prior art keywords
tooth
unerupted
erupting
teeth
medium
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German (de)
English (en)
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EP3928734C0 (fr
EP3928734A1 (fr
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Jeeyoung Choi
Chunhua Li
John Morton
Bastien Pesenti
Vadim Matov
Alexander Beliaev
Petr Ushanov
Roman A. Roschin
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Align Technology Inc
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Align Technology Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/002Orthodontic computer assisted systems
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/08Mouthpiece-type retainers or positioners, e.g. for both the lower and upper arch

Definitions

  • the present disclosure is related generally to the field of dental treatment. More particularly, the present disclosure is related to systems, methods, computing device readable media, and devices for creating a dental appliance having a cavity for an unerupted or erupting tooth.
  • Dental treatments may involve, for instance, restorative and/or orthodontic procedures.
  • Restorative procedures may be designed to implant a dental prosthesis (e.g., a crown, bridge inlay, onlay, veneer, etc.) intraorally in a patient.
  • Orthodontic procedures may include repositioning misaligned teeth and changing bite configurations for improved cosmetic appearance and/or dental function. Orthodontic repositioning can be accomplished, for example, by applying controlled forces to one or more teeth over a period of time.
  • orthodontic repositioning may be provided through a dental process that uses positioning dental appliances for realigning teeth.
  • Such appliances may utilize a thin shell of light weight and/or transparent material having resilient properties, referred to as an "aligner,” that generally conforms to a user's teeth but is slightly out of alignment with a current tooth configuration.
  • An example of orthodontic repositioning that can occur through a dental process is a process that uses one or more positioning dental appliances for realigning teeth. Placement of an appliance over the teeth can provide controlled forces in specific locations to gradually move the teeth into a new configuration. Repetition of this process with successive appliances in progressive configurations can move the teeth through a series of intermediate arrangements toward a final desired arrangement.
  • one or more teeth may not have fully emerged from the gingiva into their final position in the patient's mouth. This process is often referred to as eruption of a tooth.
  • a tooth that has not emerged from the gingiva is referred to as not erupted
  • a tooth that has emerged from the gingiva and is moving toward its final position is referred to as partially erupted
  • a tooth in its final position, when discussing eruption is referred to herein as fully erupted.
  • Such dental appliances have cavities formed in the shell of the appliance into which one or more teeth will be positioned. Further, dental appliances used as aligners rely on resilient properties of the aligner material to impart force on one or more teeth to move the teeth and as such a space in the shell for an erupting tooth has to be provided for the shell and also has to be designed to provide whatever force is desired by the treatment plan. Therefore, design of the space on the shell cannot be done in a trivial manner.
  • Natural eruption of these teeth is utilized to erupt the teeth. This process provides enough space in the arch and prevents interference with aligner structure during eruption, since even small magnitude of consistent or repeated force can impede or stop eruption.
  • the cavity for the erupting tooth may be sized incorrectly for the erupting tooth (e.g., based upon the space within the patient's mouth prior to the tooth erupting or in the early stages of eruption). Additionally, it may be difficult to predict the speed at which the tooth may erupt and, therefore, the shell may be designed such that it does not accommodate the tooth properly as it erupts. In some such instances, the tooth may contact one or more surfaces of the cavity which may slow the eruption process, cause discomfort to the patient, and/or unintentionally change the positioning of the appliance, among other possible issues.
  • US 2013/0244194 discloses an orthodontic appliance having a portion for guiding unerupted teeth into the mouth which is preformed with predicted sizes and shapes of teeth determined from sizes of other erupted adult teeth and shapes from anatomical standards.
  • the present disclosure is related to systems, methods, computing device readable media, and devices for creating a dental appliance having a cavity for an unerupted or erupting tooth.
  • Embodiments of the present disclosure can more closely predict tooth dimension and/or position.
  • Embodiments of the present disclosure also can utilize a bubbled space to form a cavity in the shell of the device for placement of the erupting tooth to better ensure natural eruption with reduced or minimized potential interference with surfaces of the dental appliance.
  • the cavity has to be sized to be accommodated by the other items around the cavity (e.g., adjacent teeth, gingiva, teeth of the opposing jaw, the tongue of the patient, etc.).
  • Embodiments of the present disclosure include embodiments that can be largely based on an automated procedure thus reducing technician process time and maximizing protocol consistency.
  • the device is appliance designed to implement at least a portion of a treatment plan, comprising a shell having a plurality of cavities therein designed to receive teeth of a jaw with at least one of the plurality of cavities being a cavity for accommodating an unerupted or erupting tooth therein, wherein at least one of a size, shape, location, and orientation of at least one of the cavities for accommodating an unerupted or erupting tooth are based upon a prediction of at least one of a size, shape, location, or orientation of the unerupted or erupting tooth.
  • embodiments of the present disclosure can include system embodiments wherein multiple dental appliances can be used in sequence to move one or more teeth according to a treatment plan developed by a treatment professional.
  • the dental appliance system can include a first appliance of a series of appliances designed to incrementally implement a treatment plan, comprising a first shell having a plurality of cavities therein designed to receive teeth of a jaw in a first stage of the treatment plan with at least one of the plurality of cavities being a cavity for accommodating an unerupted or erupting tooth therein.
  • the system can also include a second appliance of the series of appliances, comprising a second shell having a plurality of cavities therein designed to receive teeth of the jaw in a second stage of the treatment plan the second shell having a cavity that corresponds with the cavity for accommodating an unerupted or erupting tooth of the first shell and wherein the cavities for accommodating an unerupted or erupting tooth are sized, shaped, located, and/or oriented based upon a prediction of the size, shape, location, and/or orientation of the unerupted or erupting tooth according to each shell's respective treatment stage.
  • the cavities of the shell can be adjusted to more accurately fit each tooth as it erupts.
  • the cavities for accommodating an unerupted or erupting tooth each differ in at least one tooth eruption prediction factor (e.g., size, shape, location, and orientation). This can be accomplished, for example, by utilizing data representing the unerupted or erupting teeth in multiple states of eruption that is based upon the predicted size, shape, location, and/or orientation of the fully erupted teeth to adjust one or more of the size, shape, location, and orientation of the cavity.
  • tooth eruption prediction factor e.g., size, shape, location, and orientation
  • the cavities for accommodating an unerupted or erupting tooth can be sized, shaped, located, and oriented based on data including: a size, shape, location, and orientation of a tooth adjacent to the unerupted or erupting tooth and/or based on data including: a size, shape, location, and orientation of an opposing tooth (i.e., a tooth on the opposing jaw of the patient that may interact with the unerupted or erupted tooth) to the unerupted or erupting tooth.
  • an opposing tooth i.e., a tooth on the opposing jaw of the patient that may interact with the unerupted or erupted tooth
  • the cavities for accommodating an unerupted or erupting tooth can also, alternatively or additionally be sized, shaped, located, and/or oriented based on data including: a size, shape, location, and/or orientation of a tooth that is the same type of tooth as the unerupted or erupting tooth (i.e., canine, premolar, etc.).
  • the cavities for accommodating an unerupted or erupting tooth include a gingival edge and wherein the gingival edge is located and shaped based upon a prediction of the location and shape of the gingiva that will be adjacent to the gingival edge according to each shell's respective treatment stage.
  • the cavity gingival edge location and shape can be adjusted to provide more specialized force characteristics due to the adjustability between dental appliances. For example, as a tooth emerges during the stages of a treatment plan in which dental appliances are used, the gingival edge of each appliance can be shaped different to accommodate the different shape of the gingiva as the tooth emerges from it.
  • a predicted characteristic such as the predicted orientation of the erupting tooth can be made more precise, for example, by using additional information from the patient, such as, for example, if the crown and/or root of the erupting tooth is visible from a 2-dimensional (2D) scanning technique, such as an x-ray image, (e.g., the long axis orientation of the erupting tooth could be measured in the plane of the x-ray image), this information could be used as a predictor of the orientation of the crown of the erupting tooth.
  • 2D 2-dimensional
  • a characteristic can be predicted.
  • the long axis orientation of the erupting tooth could be measured in three dimensions, relative to the adjacent neighboring teeth that are visible the virtual treatment data. Then, this information could be used as a predictor of a characteristic, such as the orientation of the crown of the erupting tooth.
  • Figure 1 illustrates examples of virtual geometries of several types of teeth according to one or more embodiments of the present disclosure.
  • a number of tooth anatomies e.g., ten, twenty, one-hundred, etc.
  • a first tooth shape has a particular shape and when compared to a second tooth, of the same type, the second tooth will have a different shape with a different outer contour in multiple dimensions such that it may, for example have a larger mesiodistal (MD) length than the first tooth, but a smaller buccolingual (BL) length.
  • MD mesiodistal
  • BL buccolingual
  • the comparison can overlay the two data sets and take the data points that are furthest from a reference point (e.g., a center point in the tooth) to create a tooth shape that is the maximum dimensions of the two combined data sets.
  • a reference point e.g., a center point in the tooth
  • This methodology can be accomplished with data sets of more than two teeth (e.g., tens, hundreds, thousands, millions, etc. of data sets of teeth can be used).
  • This created generic dimensional tooth design information can be used for each target tooth to aid in predicting at least one of the size, location, shape, and/or orientation of the target tooth and to provide a general tooth shape that can be utilized for any patient's target tooth.
  • the anatomies can be provided from a variety of resources.
  • anatomies can be provided from other patient cases, one or more pontic galleries, typodonts, and/or other teeth of the patient, among other resources.
  • the selection can, for example, be made automatically (e.g., based upon computing executable instructions that compare the anatomies to each other, as discussed above, and/or to a predicted shape, size, location, and/or orientation of the unerupted or erupting tooth based on the compared anatomies) or by a treatment professional of computing device operator.
  • the generic envelope can, for example, be represented as a custom-designed parametric 3D surface model, approximating tooth geometry.
  • the generic surface is a fixed, custom-designed geometric shape, and parameters allow for scaling each dimension (e.g., mesiodistal, buccolingual, coronal-apical) independently.
  • the surface may be represented by a set of parametric surfaces (e.g., non-uniform rational B-splines).
  • control points and any other parameters of the surface can, for instance, be adjusted to approximate the outermost surface of the overlaid geometries.
  • two tooth envelopes i.e., 100 and 102 show a first envelope 101 around a canine tooth 103 and 104 and 106 show a second envelope 105 around a bicuspid tooth 107) are shown from two perspectives.
  • this information can be displayed, such as on a display of a computing device, as illustrated in Figure 1 .
  • the information is data that is used within the process of creating one or more dental appliances and is not displayed.
  • the outermost surface of the overlaid geometries creates a bubble-like form 101 that represents the maximum extent to which a tooth should extend outward from a reference point in three dimensions (at least, based upon the selected anatomies used in the calculation above).
  • a dental appliance cavity having a size, shape, location, and/or orientation similar to that of the bubble-like form with respect to that particular tooth type should not contact any surface of the erupting tooth.
  • Embodiments of the present disclosure can take this information into account when designing the dental appliances.
  • Figure 2 illustrates examples of standard virtual geometries for several types of teeth that can be created according to one or more embodiments of the present disclosure. Shown in Figure 2 are shapes based on the generic dimensional design information, for example, from Figure 1 . The shapes in Figure 2 are designed to universally envelop the maximum data points from a reference point in a comparison of multiple data sets.
  • the virtual geometry shape of the tooth and/or the bubble can be made more precise, using additional information from the patient of the target tooth. For example, if the crown of the unerupted or erupting tooth is visible from a 2D scanning technique (e.g., an x-ray image), the mesiodistal and coronal-apical size of the crown can be measured in the x-ray image, (e.g., proportionally to one or more neighboring fully-erupted teeth and used to compute the size of the geometry of the tooth to be erupted). This patient specific information can be used to modify the generic dimensional design shape to make the shape more precise to the patient's mouth.
  • a 2D scanning technique e.g., an x-ray image
  • This patient specific information can be used to modify the generic dimensional design shape to make the shape more precise to the patient's mouth.
  • the size could be measured manually and entered in the software by a user, it could be detected semi-automatically by selected one or more landmark points (e.g., four points: mesial, distal, coronal, and apical could be selected and then the process could be done automatically, via computing device executable instructions using these points) on an unerupted or erupting tooth crown and neighboring teeth, or could be detected automatically, for example, by contour detection and other image processing techniques and this information could be used in creating the generic dimensional design and/or modifying a generic dimensional design shape created from non-patient data sets.
  • landmark points e.g., four points: mesial, distal, coronal, and apical could be selected and then the process could be done automatically, via computing device executable instructions using these points
  • this information could be used in creating the generic dimensional design and/or modifying a generic dimensional design shape created from non-patient data sets.
  • the crown of the erupting tooth that has not emerged from the gingiva is visible from the output of a 3D scanning technique, such as CBCT
  • the crown surface of the unerupted tooth could be reconstructed partially or completely.
  • the crown could, for example, be completed using generic crown data (for an example of generic crown data, see patent: US 7,865,259 ).
  • the size of the crown to be erupted can be measured from the reconstructed 3D data.
  • the 3D shape of the virtual geometry to be reconstructed can be derived from the scanned geometry.
  • Such methods can be complementary to or used as an alternative to a tooth size regression model as discussed elsewhere herein.
  • Geometry 208 represents a lower 2 nd bicuspid
  • geometry 210 represents an upper 2 nd bicuspid
  • geometry 212 represents a lower canine
  • geometry 214 represents an upper canine.
  • these standard virtual geometries may be able to be utilized on a tooth of that type in many patients.
  • patients in which such standard geometries may not fit or where further precision is desired further refinement processes are discussed in more detail herein.
  • the geometries shown represent a bubble-like form that can be used to determine that shape of a cavity to be formed within a shell of a dental appliance.
  • Figure 3 illustrates an example view of a portion of a virtual model of an upper jaw and lower jaw of a patient that can be used in creating an appliance according to one or more embodiments of the present disclosure.
  • one or more of the neighboring teeth can be used to help predict the size, shape, location, and/or orientation of an unerupted or erupting tooth. For example, if the unerupted or erupting tooth is in tooth position #6 on the upper jaw 316, then one or more teeth in positions #5 and #7 (adjacent teeth) and #27 and #28 (opposing teeth) can be utilized.
  • a tooth in another part of the mouth that has already erupted (partially or fully) that is of the same tooth type can be utilized, in some embodiments.
  • one or more of the tooth eruption prediction factors may be present in the counterpart tooth (e.g., the characteristics: size, location, shape, and/or orientation) which can be used to predict the size, shape, location, and/or orientation of the erupting or unerupted tooth, alone or in combination with one or more neighboring teeth of an unerupted or erupting tooth.
  • the expected dimensions of a partially-erupted or unerupted tooth can be extrapolated from the known characteristics of one or more neighboring teeth (adjacent, opposing, and/or counterpart tooth).
  • one or more of the tooth eruption prediction factors such as, Buccolingual (BL) widths and/or Mesiodistal (MD) widths of partially erupted or fully erupted neighboring teeth can be used as regressors in a multivariate regression model, as discussed in more detail below.
  • BL buccolingual
  • MD Mesiodistal
  • Such an analysis can, for example be used in a tooth size prediction.
  • Figure 4 illustrates an example of a process for treatment planning of the present disclosure.
  • the case is first checked to determine whether or not the patient has erupting teeth at 409. If the patient does have erupting teeth, those one or more teeth are identified.
  • These processes can be accomplished by executable instructions that, for example, check tooth size, location, shape, and/or orientation to determine substantial matches to the size, location, shape, and/or orientation of a tooth in a typodont, pontic gallery or a standard virtual geometry, as discussed herein.
  • the method analyzes the data of the counterpart, adjacent, and/or opposing teeth to determine at least one dimension (e.g., X, Y, and/or Z dimension data in a three dimensional coordinate system) of each of the counterpart, adjacent, or opposing teeth to be utilized in the prediction of the size, shape, location, and/or orientation of the erupting or unerupted tooth and/or the size, shape, location, and/or orientation of the cavity to be created on the shell of one or more dental appliances at 411.
  • at least one dimension e.g., X, Y, and/or Z dimension data in a three dimensional coordinate system
  • a multivariate regression model or other suitable model such as others described herein can be utilized to further refine the dimension of the erupting or unerupted tooth and/or the size, shape, location, and/or orientation of the cavity to be created on the shell of one or more dental appliances at 413.
  • This type of model can, for example, be utilized where there are multiple adjacent, opposite, or counterpart teeth that are being used in such analysis.
  • multiple teeth can be used in a prediction model.
  • the number of teeth to be used in modeling can, for example, be identified, a model that can use that number of teeth can be selected, the regression process can be applied to the tooth data through use of the selected regression model.
  • This analysis can be used to determine one or more projected tooth dimensions as illustrated in Figure 4 .
  • one or more standard virtual geometry and/or predefined virtual geometry can be customized to match the one or more projected tooth dimensions.
  • data can be used to determine how to scale the virtual geometry size up or down to better fit with the size of the teeth of the patient.
  • a scaling factor can be applied to one or more virtual geometry dimensions to match the one or more projected tooth dimensions or create a bubbled virtual geometry.
  • a scaling factor can be used to scale a dimension up or down. For example, in order to ensure that the erupting tooth does not contact a surface of the cavity, a Z dimension of the projected tooth dimensions could be scaled up such that the tooth would not extend that far from the patient's gingiva or other reference point.
  • each dimension could be scaled differently.
  • the X dimension scaled up by 5%
  • the Y dimension by 3%
  • the Z dimension by 7%.
  • a scaling factor can also be applied to one or more of the standard virtual geometry dimensions. This can be done to change the dimensions of virtual geometries from various sources before they are compared to the projected dimensions of the erupting or unerupted tooth or to adjust the virtual geometry dimensions so that their dimensions will be different going forward as applied to the next patient.
  • each patient may have a customized fit for their dental appliances based on the individualized analysis done utilizing one or more of the processes described above.
  • the virtual geometry can then be inserted into a virtual model of the patient's jaw for planning of the movement of the teeth of the patient and/or design of one or more dental appliances, as shown at 421.
  • the virtual geometry can then be positioned and oriented to provide a treatment plan for treating the patient based on the modified geometry provided by the embodiments of the present disclosure, as illustrated at 423.
  • the number of regressors and/or models can vary depending on the availability of partially or fully erupted neighboring teeth.
  • 5-regressor model can be chosen if two adjacent teeth, two opposing teeth, and the counterpart tooth on the other side of the patient's arch are all fully erupted.
  • a 3-regressor model could be selected if, for example, two adjacent teeth and one opposing tooth are fully erupted. Then, a standard virtual geometry that has been refined based on such a regression can be scaled up/down accordingly to contain the projected unerupted tooth with an appropriately sized and shaped bubbled space. As discussed herein, the scaling can be different for different dimensions of the virtual geometry.
  • Bubble thickness for each virtual geometry can be constant or varying, for example, in MD and BL directions. All of the numerical calculations including expected tooth dimension and/or scaling factor can be automated (e.g., via executable instructions) in order to reduce or minimize manual adjustment by treatment professionals or computing device operators and to improve treatment protocol consistency, among other potential benefits.
  • Embodiments that create virtual geometries of a customized tooth size with a bubbled space can, for example, minimize potential size mismatch of virtual geometries with the real tooth during/after eruption, among other potential benefits.
  • a placed virtual geometry might collide with a tooth (e.g., virtual geometry) in the opposing arch (i.e., an inter-arch collision), which could result in an open bite (where the jaws do not mate or close fully) upon occlusion.
  • a tooth e.g., virtual geometry
  • an inter-arch collision i.e., an inter-arch collision
  • One solution for this is to reshape the virtual geometry by removing the volume of the cavity that will collide with the opposing arch.
  • the volume can, for example, be dynamically adjusted according to the staged position of the opposing teeth during the treatment to ensure desired occlusion.
  • the volume to be removed can be identified by, for example, in a virtual model, moving the jaws to a fully closed position and then reviewing the data to identify where teeth may be overlapping. Once overlapped areas are identified, modifying the virtual geometry in one or more dimensions to remove any overlapping areas and/or modifying one or more surfaces to better mate the surfaces of opposing teeth together.
  • Figure 5 provides an example of a cavity for an erupting tooth in the left image and an example of a cavity for an erupting tooth according to one or more embodiments of the present disclosure in the right image.
  • the gingival edge (e.g., 524 and 530 of the images of Figure 5 ) of the dental appliance can be shaped to provide greater force distribution to the rest of the appliance, among other benefits.
  • gingival edge 524 for virtual geometries is, in many cases, virtually bypassed which can result in a short crown height of the cavity 520 in manufactured aligners. The goal of such implementations is to prevent unwanted contact with erupting tooth 522.
  • the gingival edge 530 of the cavity 526 having the erupting tooth 528 therein can be shaped similarly to when the tooth is fully erupted and thus aligner mechanical integrity is not compromised and there are fewer chances for distortion and breakage.
  • the gingival edge can be adjusted from one appliance to a subsequent appliance worn during a later stage in treatment as the tooth continues to erupt and, therefore, one or more appliances in a series of appliances for implementing a treatment plan may have differently shaped gingival edges.
  • Figure 6 provides an example of a straight line placement for an erupting tooth in the left image and an example of an arch line placement for an erupting tooth according to one or more embodiments of the present disclosure in the right image.
  • virtual geometries were placed in the arch based on a tooth placement algorithm where the virtual geometry was positioned in the mid-point 639 of a straight line 637 connecting the contact points (i.e., the points at which two adjacent teeth contact each other or would contact each other if they were moved into contact) of two adjacent teeth. Therefore, prior art virtual geometry placement algorithm can result in inherent errors where virtual geometries may be positioned more lingually than where the naturally erupting tooth would be. This shortcoming can be more pronounced with canines than premolars, since canine location in the arch typically is in the most convex curvature area.
  • Embodiments of the present disclosure can utilize a placement methodology that is based on an arch form analysis (i.e., accounting for the arched shape of the jaws of a patient and the arched pattern in which the teeth are positioned thereon) rather than a straight line methodology to reduce such inherent placement errors.
  • the right image of Figure 6 provides such an embodiment.
  • the arch form is illustrated by line 635.
  • the methodology takes into account the location of the arch form 635.
  • the arch form concept is incorporated into the computation used to position teeth.
  • historical data from one or more patients can include, for example, tens, hundreds, thousands, or millions of patients
  • a distance or numerical value between a naturally erupted tooth position and a tooth position placed at the mid-point of a straight line, can be determined. This predetermined distance or amount can then be applied to any patient and used to adjust the patient's tooth such that it gets closer to the arch form.
  • the arch form information can be utilized to identify, where the tooth will be positioned such that it contacts the two adjacent teeth (e.g., that dots at the end of the straight line 637) and the line of the arch form (e.g., at point 641). As can be seen from this illustration, the tooth is therefore moved out a distance from mid-point of the straight line which should place the tooth in a more desirable position.
  • Figure 7 illustrates examples of canine teeth that are naturally erupted with buccal displacement and palatal displacement.
  • the images illustrate the different positions of two teeth 731 and 733.
  • the left image provides an example of buccally displaced canine teeth and the the right image provides an example of palatally displaced canine teeth. Although these teeth are erupted, Figure 7 is provided to allow the reader to better understand the concepts of buccal displacement and palatal displacement.
  • the available arch space is not sufficiently large for the erupting tooth.
  • the normal eruption of the tooth can be hindered such that the tooth may not erupt into a location along the arch form, as shown in the examples of Figure 7 .
  • the tooth may erupt at deviated locations to avoid collision with neighboring teeth, resulting in namely buccal displacement or palatal displacement of the erupting tooth, as defined in the current disclosure.
  • buccal displacement occurs when a tooth erupts in a more buccal position than its adjacent teeth and/or arch form
  • palatal displacement occurs when a tooth erupts in more lingual position than its adjacent teeth and/or arch form.
  • Such displacements may become a challenge for tooth placement algorithms and therefore, a treatment professional may have to provide input to make sure that the dental model accurately represents the patient's dentition.
  • various embodiments of the present disclosure can be utilized to use available space size in the arch and the predicted dimension of erupting tooth in a single- or multi-variate regression model (e.g., a buccal displacement canine (BDC) prediction model) to determine a potential displacement magnitude of the erupting tooth for buccally displaced canines in upper and/or lower jaws.
  • the potential displacement magnitude can be determined, for example, by determining the difference in available space size and predicted tooth Mesioddistal (MD) width as a first regressor in the BDC prediction model.
  • the BDC prediction model can, for example, be additionally applied to the tooth placement algorithm to improve accuracy of virtual geomtry location for an erupting tooth.
  • Clinical assessment can be made by treatment professionals, for example, by using gingival palpation, visual inspection, X-ray, CBCT scan, etc. In this manner, the displacement of one or more teeth can be accounted for in design of one or more of the dental appliances fabricated for a patient.
  • appliances according to the present disclosure can include, in some embodiments, a plurality of incremental dental position adjustment appliances.
  • the appliances can be utilized to incrementally implement a treatment plan such as by affecting incremental repositioning of individual teeth in the jaw, among other suitable uses.
  • appliances can be fabricated according to a virtual dental model that has had positions of a number of teeth adjusted according to one or more embodiments of the present disclosure.
  • Appliances can also include any positioners, retainers, and/or other removable appliances for finishing and/or maintaining teeth positioning in connection with a dental treatment. These appliances may be utilized by the treatment professional in performing a treatment plan.
  • a treatment plan can include the use of a set of appliances, created according to models described herein.
  • An appliance can, for example, be fabricated from a polymeric shell, and/or formed from other material, having a plurality of cavities therein.
  • the cavities can be designed (e.g., shaped) to receive one or more teeth and/or apply force to reposition one or more teeth of a jaw from one teeth arrangement to a successive teeth arrangement.
  • the shell may be designed to fit over a number of, or in many instances all, teeth present in the upper or lower jaw.
  • a cavity can be shaped to mate with a particular tooth.
  • a particular cavity can be shaped to mate with three surfaces of a corresponding tooth to be received therein.
  • the cavity may be slightly out of alignment with a current configuration of the particular tooth (e.g., to facilitate aligning the particular tooth to a desired configuration), but the cavity can generally conform to the shape of the particular tooth such that there is not much space between the cavity and the particular tooth when the appliance is worn.
  • a "first stage” does not necessarily mean the original stage of a treatment plan, but is a relative term with respect to other stages.
  • the "first stage” may be a second stage of a 25 stage treatment plan, while the “second stage” may be a tenth stage of the 25 stage treatment plan, with the "third stage”, for example, being a 15th stage of the 25 stage treatment plan, and the "fourth stage” may be a 24th stage of the 25 stage treatment plan.
  • both an upper appliance an appliance designed to fit over teeth of a user's upper jaw
  • lower appliance an appliance designed to fit over teeth of a user's lower jaw
  • Figure 8 illustrates a system for treatment planning according to one or more embodiments of the present disclosure.
  • a number of embodiments of the present disclosure include instructions that are executable by a processor (e.g., software), which can be fixed in a non-transitory computing device readable medium, to model, for example, a user's jaws (e.g., including teeth, roots, gingiva, and/or supporting structure, etc.).
  • a processor e.g., software
  • a non-transitory computing device readable medium to model, for example, a user's jaws (e.g., including teeth, roots, gingiva, and/or supporting structure, etc.).
  • the instructions can be executed to create and/or modify a treatment plan to incrementally adjust the user's teeth and/or bite, among other adjustments, via application of a series of appliances as described herein.
  • the instructions can be executed to provide modified models of the user's jaws for each of the various stages of the treatment plan for fabrication (e.g., via rapid prototyping such as stereolithography) of physical models corresponding to the virtual models.
  • the physical models can be used for the fabrication (e.g., via thermoforming) of appliances thereover.
  • executable instructions can create the appliances directly from the virtual model without the use of a mold.
  • Figure 8 illustrates a system for treatment planning according to one or more embodiments of the present disclosure.
  • the system includes a computing device 832 having a number of components coupled thereto.
  • the computing device 832 includes a processor 834 and memory 836.
  • the memory 836 can include various types of information including data 838 and executable instructions 840, as discussed herein.
  • the memory can be a non-transitory computing device readable medium having instructions stored thereon that are executable by a processor to cause a computing device perform various functions as described herein. Additionally, memory can hold data that can be used in the performance of the executable instructions (e.g., data regarding the dimensions of a neighboring tooth).
  • Memory and/or the processor may be located on the computing device 832 or off the device, in some embodiments.
  • a system can include a network interface 842. Such an interface can allow for processing on another networked computing device or such devices can be used to obtain information about the patient or executable instructions for use with various embodiments provided herein.
  • a system can include one or more input and/or output interfaces 844. Such interfaces can be used to connect the computing device with one or more input or output devices.
  • the system includes connectivity to a scanning device 846, a camera dock 848, an input device 850 (e.g., a keyboard, mouse, etc.), a display device 852 (e.g., a monitor), and a printer 854.
  • the processor 834 can be configured to provide a visual indication of a virtual model on the display 852 (e.g., on a GUI running on the processor 834 and visible on the display 852).
  • the input/output interface 844 can receive data, storable in the data storage device (e.g., memory 836), representing the virtual model (e.g., corresponding to the patient's upper jaw and the patient's lower jaw).
  • the scanning device 846 can be configured to scan a physical mold of a patient's upper jaw and a physical mold of a patient's lower jaw. In one or more embodiments, the scanning device 846 can be configured to scan the patient's upper and/or lower jaws directly (e.g., intraorally).
  • the camera dock 848 can receive an input from an imaging device (e.g., a 2D imaging device) such as a digital camera or a printed photograph scanner.
  • an imaging device e.g., a 2D imaging device
  • the input from the imaging device can be stored in the memory 836.
  • Such connectivity can allow for the input and/or output of virtual model information or instructions (e.g., input via keyboard) among other types of information.
  • virtual model information or instructions e.g., input via keyboard
  • FIG. 8 Such connectivity can allow for the input and/or output of virtual model information or instructions (e.g., input via keyboard) among other types of information.
  • the processor 834 in association with the memory 836, can be associated with data and/or application modules.
  • the processor 834 in association with the memory 836, can store and/or utilize data and/or execute instructions to provide treatment planning that includes an attachment structure.
  • Such data can include the virtual model described herein (e.g., including a first jaw, a second jaw, a number of appliances, etc.).
  • Such executable instructions can include instructions for attachment structure design and/or placement, force calculation, engagement force calculation, and/or treatment planning, among other functions.
  • Instructions for appliance design and/or cavity size, shape, and positioning can be configured to create at least one cavity into which an erupting tooth will be positioned on a virtual model of a patient's jaw.
  • the executable instructions can, for example, be executed to perform a method including to: receive, via a computing device, data representing a plurality of teeth, identify data indicating which of the plurality of teeth are unerupted or erupting, evaluate the data for tooth size information, predict size and orientation of the unerupted or erupting teeth after they have fully erupted using the tooth size information, generate new data representing the unerupted or erupting teeth in multiple states of eruption based upon the predicted size and orientation of the fully erupted teeth, and generate a series of incremental tooth arrangements with the new data to define a proposed orthodontic treatment based on the new data representing the unerupted or erupting teeth in multiple states of eruption.
  • executable instructions can be utilized, for example, wherein evaluating the data for tooth size information includes obtaining dimensional data for at least one dimension of at least one of a tooth adjacent to the unerupted or erupting tooth or an opposing tooth to the unerupted or erupting tooth. Evaluating the data for tooth size information can also include determining a first projected dimension for the unerupted or erupting tooth based on the dimensional tooth data.
  • Generating new data representing the plurality of teeth in a fully erupted state can, for example, include determining a scaling factor for the first projected dimension of a cavity of a virtual dental appliance positioned to accommodate the unerupted or erupting tooth as the tooth erupts.
  • the scaling factor can, for instance, be based on a calculation of available space in a corresponding dimension around the unerupted or erupting tooth and sized such that the unerupted or erupting tooth will not contact a surface of the cavity as the tooth erupts during a period of treatment.
  • the period of treatment can, for example, be from a current state of the plurality of the teeth through the end of a treatment plan or one period in a treatment plan that is divided into multiple, sequential periods of treatment, among other suitable periods of treatment.
  • Figure 9 illustrates an example of a method embodiment of the present disclosure for creating a dental appliance having a cavity for an unerupted or erupting tooth.
  • the method of Figure 9 is utilized for defining an unerupted or erupting tooth during a proposed orthodontic treatment and includes identifying, via a computing device, whether a patient's arch contains an unerupted or erupting tooth, at block 960.
  • the method also includes, obtaining dimensional data for at least one dimension of at least one tooth of the patient, at block 962.
  • Obtaining dimensional data for at least one dimension of at least one tooth of the patient can, for example, include obtaining dimensional data for at least one dimension of at least one of a tooth adjacent to the unerupted or erupting tooth or an opposing tooth to the unerupted or erupting tooth.
  • the method provides, determining a first projected dimension for the unerupted or erupting tooth based on the dimensional tooth data.
  • the method also provides that determining a scaling factor for the first projected dimension of a cavity of a dental appliance positioned to accommodate the unerupted or erupting tooth as the tooth erupts, at block 966.
  • the scaling factor can, for example, be based on a calculation of available space in a corresponding dimension around the unerupted or erupting tooth and sized such that the unerupted or erupting tooth will not contact a surface of the cavity as the tooth erupts during a period of treatment.
  • creating the dental appliance configured to reposition at least one tooth of the patient, the dental appliance including the cavity sized according to the determined scaled first projected dimension for the unerupted or erupting tooth.
  • the cavity sized according to the determined scaled first projected dimension for the unerupted or erupting tooth can, for example, be positioned to accommodate the unerupted or erupting tooth as the tooth erupts during the period of treatment.
  • the dental appliance configured to reposition at least one tooth of the patient can be a virtual dental appliance (e.g., for use in treatment planning and/or dental appliance design) or a physical dental appliance (e.g., to be worn by a patient to, for example, implement a portion or an entire treatment plan.
  • a virtual dental appliance e.g., for use in treatment planning and/or dental appliance design
  • a physical dental appliance e.g., to be worn by a patient to, for example, implement a portion or an entire treatment plan.

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  • Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • General Engineering & Computer Science (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Claims (13)

  1. Support non transitoire lisible par dispositif informatique sur lequel sont stockées des instructions qui sont exécutables par un processeur pour amener un dispositif informatique à :
    acquérir à partir d'un modèle virtuel de la mâchoire d'un patient des dimensions connues d'une dent adjacente à une dent enclavée ou en cours d'éruption, d'une dent opposée à la dent enclavée ou en cours d'éruption, ou d'une homologue à la dent enclavée ou en cours d'éruption (411) ;
    appliquer un modèle de régression multivariée utilisant les dimensions connues (413) pour calculer les dimensions projetées de la dent enclavée ou en cours d'éruption (415) ;
    personnaliser une géométrie virtuelle standard et/ou une géométrie virtuelle prédéfinie en utilisant les dimensions projetées de la dent enclavée ou en cours d'éruption (417) ; et
    insérer la géométrie virtuelle personnalisée dans le modèle virtuel de la mâchoire du patient, et planifier le déplacement des dents du patient et concevoir une série d'aligneurs orthodontiques amovibles à l'aide du modèle virtuel (421), la série d'aligneurs orthodontiques amovibles étant conçue pour être portée par le patient de manière à aligner progressivement les dents conformément au déplacement prévu.
  2. Support selon la revendication 1, lesdites instructions étant exécutables pour amener le dispositif informatique à identifier si l'arcade d'un patient contient une dent enclavée ou en cours d'éruption.
  3. Support selon la revendication 1, lesdites instructions étant exécutables pour amener le dispositif informatique à acquérir les dimensions connues en déterminant au moins une donnée de dimension X, Y ou Z dans un système de coordonnées tridimensionnelles de chacune des dents homologues, adjacentes et opposées.
  4. Support selon la revendication 1, lesdites instructions étant exécutables pour amener le dispositif informatique à appliquer un modèle de régression multivariée pour prédire la taille, la forme, l'emplacement et/ou l'orientation de la dent en cours d'éruption ou enclavée.
  5. Support selon la revendication 1, lesdites instructions étant exécutables pour amener le dispositif informatique à appliquer un modèle de régression multivariée pour prédire la taille, la forme, l'emplacement et/ou l'orientation de la cavité devant être créée sur une coque de chacun de la série d'aligneurs orthodontiques amovibles.
  6. Support selon la revendication 5, ladite cavité étant dimensionnée et positionnée pour accueillir la dent enclavée ou en cours d'éruption lorsque la dent fait éruption pendant une période de traitement.
  7. Support selon la revendication 1, lesdites instructions étant exécutables pour amener le dispositif informatique à faire varier le nombre de régresseurs en fonction de la disponibilité de dents voisines ayant fait éruption partiellement ou complètement.
  8. Support selon la revendication 1, lesdits aligneurs orthodontiques étant des aligneurs orthodontiques virtuels.
  9. Support selon la revendication 1, lesdits aligneurs orthodontiques étant des aligneurs orthodontiques physiques.
  10. Support selon la revendication 1, ladite géométrie virtuelle standard et/ou une géométrie virtuelle prédéfinie étant basée sur une galerie pontique.
  11. Support selon la revendication 1, lesdites instructions étant exécutables pour amener le dispositif informatique à afficher une indication visuelle du modèle virtuel.
  12. Support selon la revendication 11, lesdites instructions étant exécutables pour amener le dispositif informatique à afficher une enveloppe autour de la dent enclavée ou en cours d'éruption, ladite enveloppe étant créée à partir d'une conception dimensionnelle générique qui enveloppe la surface la plus externe d'une pluralité de géométries superposées.
  13. Support selon la revendication 12, ladite surface la plus externe de la pluralité de géométries superposées comprenant une forme de type bulle qui représente l'étendue maximale selon laquelle une dent doit s'étendre vers l'extérieur à partir d'un point de référence en trois dimensions.
EP21184102.8A 2014-11-13 2015-11-11 Support lisible par ordinateur avec instructions pour calculer des dimensions projetées d'une dent ayant fait éruption ou pas Active EP3928734B1 (fr)

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US14/541,021 US9744001B2 (en) 2014-11-13 2014-11-13 Dental appliance with cavity for an unerupted or erupting tooth
EP15826154.5A EP3217917B1 (fr) 2014-11-13 2015-11-11 Méthode de création d'un appareil dentaire doté d'une cavité pour dent enclavée ou faisant son éruption
PCT/IB2015/002134 WO2016075527A2 (fr) 2014-11-13 2015-11-11 Appareil dentaire doté d'une cavité pour dent enclavée ou faisant son éruption

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EP3928734A1 EP3928734A1 (fr) 2021-12-29
EP3928734C0 EP3928734C0 (fr) 2023-12-06
EP3928734B1 true EP3928734B1 (fr) 2023-12-06

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EP15826154.5A Active EP3217917B1 (fr) 2014-11-13 2015-11-11 Méthode de création d'un appareil dentaire doté d'une cavité pour dent enclavée ou faisant son éruption
EP21184102.8A Active EP3928734B1 (fr) 2014-11-13 2015-11-11 Support lisible par ordinateur avec instructions pour calculer des dimensions projetées d'une dent ayant fait éruption ou pas

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EP (2) EP3217917B1 (fr)
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CN111631831A (zh) 2020-09-08
CN107106258B (zh) 2020-06-05
US20160135924A1 (en) 2016-05-19
CN111631831B (zh) 2022-08-02
US10537405B2 (en) 2020-01-21
US20200155275A1 (en) 2020-05-21
WO2016075527A9 (fr) 2017-01-19
CN107106258A (zh) 2017-08-29
US20170340415A1 (en) 2017-11-30
EP3217917B1 (fr) 2021-07-07
US11596499B2 (en) 2023-03-07
US9744001B2 (en) 2017-08-29
EP3928734A1 (fr) 2021-12-29
US20230200942A1 (en) 2023-06-29
WO2016075527A3 (fr) 2016-07-21
WO2016075527A2 (fr) 2016-05-19
EP3217917A2 (fr) 2017-09-20

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